The rate of suicide attempts and mental illness among children and adolescents has increased over the years (Nock et al., 2013). These adolescents go to hospital to receive medical or psychiatric treatment and are admitted to general pediatric wards (O’Brien, Harvey, Young, Reardon, & Creswell, 2017). The nursing and medical staff (henceforward staff) in these wards have rarely received specialist training in psychiatry. The therapeutic encounter with these children and adolescents can evoke a range of emotions, attitudes, and opinions in the staff, related to the patients as well as to mental illness and suicidal tendencies, and can also resonate in the staff’s professional and personal spheres (Clark, Usick, Sanderson, Giles- Smith, & Baker, 2014). The aim of this study was to explore the experiences of nursing and medical staff members, who worked in general pediatric wards and who treated, among others, children and adolescents admitted to the general pediatric ward either with symptoms of mental illness or following a suicide attempt. Accordingly, the following research questions were examined: (1) What feelings arise in staff members towards these patients? (2) How do staff members describe their therapeutic approach towards these patients? (3) How do staff members perceive the behaviors of young patients (children and adolescents) with mental illness and suicidal tendencies?
Methods:
This was a qualitative study, aimed at understanding and interpreting the subjective meaning of people’s experiences of a phenomenon (Ashworth, 2015); in this case, attempting to gain an in-depth understanding of the experiences of nurses and physicians, who treated children and adolescents either with symptoms of mental illness or following a suicide attempt. The sample was purposive (Patton, 2015) and included 20 participants—10 nurses and 10 physicians—in two medical centers in northern Israel. Data were gathered using in-depth semi-structured interviews, based on an interview guide that included several content domains. In addition to the interviews, participant observations were performed in one pediatric ward. Data analysis was performed inductively, using thematic analysis.
Results:
Three main themes emerged from data analysis: (1) Being a “watchful spotlight” or an “empathic friend”? This theme presents the staff’s experiences of the encounter with children and adolescents with mental illness and suicidal tendencies as a therapeutic relationship. They move along a continuum between emotional closeness and distance, while attempting to balance professional and personal boundaries during the treatment itself as well as in their private lives; (2) A “problem–fix–solution” working pattern: This theme addresses nurses’ and physicians’ modes of seeking solutions to problems, i.e., looking for a cure for the young patients’ illness while focusing on fixing the problem: achieving medical results and improving the patients’ condition; (3) Suicidal tendencies and mental illness in the general pediatric ward: This theme relates to the staff’s perceptions of patients with suicidal tendencies and mental illness, labeling them under one category while differentiating them from a second category of other patients in the ward.
Conclusion:
The nursing and medical staff experienced difficulty in containing the emotional distress of young patients with mental symptoms. They oscillated along a continuum of emotional involvement, ranging between closeness and distance, considering the balance of boundaries to draw between themselves and their patients during treatment. The staff members were concerned that such emotional involvement would negatively impact their professional competence and might even spill over to their private life sphere. Thus, they acted according to a pattern of “problem–fix–solution” (Dianati & Adib- Hajbaghery, 2012), focusing on providing nursing/medical treatment, curing and solving medical/physical problems (the Cure model), while minimizing or avoiding reference to the caring aspects of treatment (Dobrowolska et al., 2014), such as the patient’s emotional and mental condition, as well as his/her familial or social relationships (the Care model; O’Brien et al., 2017). The staff appeared to have scarce knowledge and insufficient therapeutic skills to treat children and adolescents with mental health symptoms, which seemed to undermine their professional self-image (Roberts, Crosland, & Fulton, 2013). Finally, patients admitted with mental symptoms were labeled and treated differently than the other patients in the ward. Such labeling was explained by attribution of guilt: Whereas the staff perceived physical illness as beyond the patient’s control, mental symptoms, and particularly suicidal attempts, were perceived negatively, as the patient’s fault.
The findings of this study expand the limited knowledge on the experiences of nurses and physicians who encounter young patients either with mental illness or following a suicide attempt. Future studies are recommended to include staff from community primary care, as well as other healthcare professionals, such as psychiatrists, psychologists, social workers, and occupational therapists. Studying other professionals’ narratives on similar encounters can shed light on common experiences as well as on those unique to each profession. The insights gained from the study can assist in developing personal, professional, and organizational strategies, as well as training and orientation programs for nursing and medical staff to fine-tune their awareness of their reactions to patients with mental symptoms admitted to general pediatric wards. Such programs can also contribute to raising awareness of these patients’ needs. Hence, staff members will cope better in their encounters with these patients, and the quality of care will improve.